mahin naderifar

While intravenous injections are essential in life-saving situations, their routine use can lead to various complications, particularly phlebitis, which negatively impacts patients' physical and psychological health. This research aims to evaluate the effectiveness of topical aloe vera gel compared to 2% chlorhexidine gluconate in preventing phlebitis associated with peripheral venous catheters.

This three-arm randomized controlled trial, executed in 2024 at a university-affiliated hospital situated in southern Iran, enrolled 90 hospitalized individuals receiving intravenous therapy. The study employed convenience sampling for participant recruitment, followed by permuted block randomization with a block size of six to allocate participants into three distinct groups, each comprising 30 patients. Aa (aloe vera group): Disinfection with 70% alcohol, and the catheter fixation with an adhesive dressing impregnated with aloe vera gel; Bb (chlorhexidine group): Disinfection with 70% alcohol and chlorhexidine, followed by fixation with a chlorhexidine-impregnated adhesive dressing; and C (control group): Disinfection with 70% alcohol and standard adhesive dressing. The catheter insertion site was systematically evaluated for the incidence of phlebitis using a standardized phlebitis checklist at discrete time points: 12, 24, 36, 48, 60, and 72 hours post-sampling. Statistical analysis of the collected data was performed employing SPSS version 25 statistical software. A significance threshold of α = 0.05 was adopted for all statistical tests, which included Chi-square tests and one-way analysis of variance (ANOVA).

At 72 hours post-intervention, the incidence of phlebitis demonstrated a statistically significant disparity between the groups (p = 0.005). Conversely, no significant intergroup differences were evident in the manifestation of phlebitis symptoms at the 12-hour (p = 0.999), 24-hour (p = 0.493), 36-hour (p = 0.493), 48-hour (p = 0.186), and 60-hour (p = 0.064) time points after the intervention. Specifically, out of 30 participants in the aloe vera group, 12 (40%) remained asymptomatic for phlebitis—defined by the absence of redness, edema, pain, and vein induration—up to the 72-hour assessment. In comparison, the chlorhexidine group exhibited 5 (16.7%) patients, while the control group presented with only 2 (6.7%) patients who did not display phlebitis symptoms during this period.

Based on the observed outcomes, nurses may consider using aloe vera gel to reduce phlebitis in patients requiring catheterization for more than 48 hours, due to its anti-inflammatory properties and non-pharmacological benefits. However, this recommendation should be approached cautiously, pending further rigorous research to validate these initial findings and develop standardized guidelines. Future studies should investigate the long-term effects of aloe vera gel, compare its effectiveness with other interventions, and assess patient outcomes in various clinical settings to better understand its role in preventing phlebitis.

Context: 

Mourning following the death of a loved one is a natural and necessary process, but some people lack the skills and abilities to deal with the grief process, which can lead to many psychological problems. Bereaved children are a vulnerable population at risk of social and psychological harm.

The present study aimed to investigate the effects of grief on children and effective interventions to increase adaptation to it. Evidence Acquisition: The present study was a review-type design based on the review of the literature on loss and bereavement in children, reactions, and effective interventions. The literature search was conducted in PubMed, Scopus, and Web of Science databases, as well as in the Google Scholar search engine up to December 2024. Relevant keywords and their combinations used for the literature search were as follows: Loss, bereavement, children.

Supportive interventions in children's traumatic bereavement include cognitive behavioral therapy, developing coping skills, relaxing activities (yoga), and creative counseling techniques (expressing feelings or experiences through poems, drawings, singing, dancing, writing and drawing trauma narratives, epitaphs which are short texts performed in honor of a deceased person, holding a memorial service, holding a holiday program that focuses on helping the child cope with the grief during important family holidays).

Childhood grief reactions are distinct from those in adults and are affected by developmental and contextual factors such as the age of the child and changes in caregiving environments. Empirically supported interventions can help young people to navigate the many grief-related challenges.

Mothers are typically the primary caregivers for children with type 1 diabetes, a role that significantly impacts their lives. Since spirituality has been identified as a key dimension of self-care, this study aimed to determine the effect of self-care training based on mothers' spirituality on the metabolic control of children with type I diabetes.

In this clinical trial, 70 mothers of children with type I diabetes were selected and randomly assigned to two groups: an intervention group (35 participants) and a control group (35 participants). Data were collected using a demographic profile questionnaire and by measuring metabolic control indicators, including glycosylated hemoglobin (HbA1c), triglycerides, and cholesterol levels.

The independent t-test showed a statistically significant difference in mean glycosylated hemoglobin scores between the intervention and control groups before and after the intervention. However, after controlling for pre-test scores using ANCOVA, no statistically significant difference was observed in the average glycosylated hemoglobin levels between the intervention group (7.65 to 7.04) and the control group (7.24 to 6.63).Similarly, the average triglyceride levels in the intervention group changed from 85.46 ± 14.58 to 85.46 ± 16.46, and in the control group from 83.51 ± 29.06 to 83.86 ± 24.81. Cholesterol levels in the intervention group changed from 178.66 ± 10.67 to 178.49 ± 11.64, while in the control group, they shifted from 174.17 ± 11.39 to 175.61 ± 12.51. However, the independent t-test did not reveal a statistically significant difference in triglyceride or cholesterol scores between the two groups (p < 0.05).

The spiritual self-care educational intervention improved the ability of mothers to oversee the metabolic control of their children with type 1 diabetes in a sample of the Iranian population. However, the findings suggest that mothers likely require more comprehensive support than what was provided in this study. Solely offering spiritual support appears insufficient. Therefore, holistic support systems addressing the multifaceted needs of these mothers are necessary to enhance their caregiving roles effectively.

Nurses most frequently face ethical challenges due to their direct contact with patients. Accordingly, the present study aimed to investigate the ethical challenges faced by nurses who provided care to patients with COVID-19. This qualitative study was conducted using conventional content analysis. A total of 13 nurses who were selected through purposive sampling participated in the study. Data were collected via in-depth and semi-structured interviews until data saturation from June to late November 2021. Data were analyzed simultaneously with data collection using qualitative content analysis based on the steps proposed by Graneheim and Lundman. Besides, data accuracy and robustness were checked, and ethical standards were followed. Data analysis led to the identification of two main themes including threatening adherence to professional obligations and experiencing moral distress in patient care. Based on the findings, nurses mentioned a large number of ethical challenges such as the risk of injustice and loss of responsibility in providing care, decision conflicts, weakening ethical concepts such as patience and kindness, conflict between professional obligations and personal commitments, and the lack of attention to metaphysical beliefs. The results of this study highlighted the importance of educational planning, psychological and economic support, gratitude and empathy shown by authorities, providing security in the workplace, and developing face-to-face psychological interventions based on nursing needs.

Ventilator-associated pneumonia (VAP) is one of the most common healthcare-related infections in pediatric and neonatal intensive care units. In the present study, due to the importance of prevention, early identification, and treatment of VAP, nasal and endotracheal microorganisms were determined in intubated patients admitted to the pediatric intensive care unit.

The present study aims to determine the nasal and endotracheal (ETT) microorganisms in pediatric patients with intubated VAP admitted to the pediatric intensive care unit (PICU).

This cross-sectional two-group case-control study was conducted on 90 intubated patients: Sixty patients with VAP (30 nasal, 30 tracheal tubes) and 30 patients without VAP, hospitalized in the PICU department of Amir al Mominin Ali (AS) Hospital in Zabol, Iran, from March 2018 to December 2018. The criteria for diagnosing VAP was the clinical pulmonary infection score (CPIS). In both case and control groups, samples were collected from nasal tubes using nasal swabs and from tracheal tubes (ETT) as tracheal aspirates from intubated patients, and sent to the laboratory for culture. The collected samples were interpreted in the microbiology laboratory to identify microorganisms. Data collection was done using a demographic information questionnaire and the clinical pulmonary infection score CPIS. The data was entered into SPSS 20 statistical software and analyzed.

The results of the present study showed that gender and age of patients do not affect the incidence of VAP, but children with VAP have a significantly longer stay in the PICU. Microbiological examination showed that Klebsiella and Escherichia coli (13.3%) were the most frequent among the positive nasal samples, and Klebsiella and E. coli (36.7%) were the most frequent among the positive tracheal samples. The diversity of microbes observed in ETT samples was also higher.

The present study showed that the duration of hospitalization in the pediatric intensive care unit, as well as the age of hospitalized patients, can increase the risk of VAP. Additionally, nasal sampling is effective in identifying and differentiating VAP patients. It is suggested to reduce the duration of hospitalization in these departments as much as possible and to pay more attention to older children to prevent the increase of VAP. The results indicate that nasal bacteria play a role in the more severe occurrence of ventilator-induced pneumonia. Therefore, it is recommended to use broad-spectrum antibiotics and implement preventive nursing measures. If possible, starting feeding earlier through a gastric tube is also suggested.

The Corona epidemic has aggravated the stressful factors on health care systems; in this case, health care workers suffer from job burnout. It is better to use remote psychotherapy methods and appropriate treatment protocols. n this study, the researchers aimed to investigate the impact of telenursing training on job burnout in nurses who had previously contracted COVID-19.

This research employed a quasi-experimental design with a pre and post-test group comparison. It involved two groups, each consisting of 20 nurses who had experienced COVID-19 and exhibited high levels of job burnout. The data collection tool was the Maslach Burnout questionnaire along with demographic information. Both groups completed these questionnaires before the intervention. The experiment group underwent a telenursing training intervention conducted through WhatsApp, consisting of five sessions at five-day intervals. The training encompassed various teaching methods, such as explanatory text, PowerPoint presentations, and audio files. The control group did not receive any intervention. After 20 days from the completion of the training sessions, both groups retook the job burnout questionnaire.

The independent t-tests showed no significant difference in burnout level and severity between experiment and control groups before the intervention (p>0.05). However, after telenursing training in the experiment group, the average scores for burnout level and severity were significantly different between experiment and control groups (p<0.001), which indicates a positive effect of telenursing training on all dimensions of job burnout, including emotional exhaustion, dysfunction, depersonalization, and job conflict.

Telenursing-based training appears to be an effective method for reducing the intensity and levels of burnout among nurses with a history of COVID-19 infection. This suggests that telenursing training can be a valuable tool to mitigate job burnout in this specific group of healthcare professionals.

Phlebitis and pain are among intravenous injection’s most common side effects. Different pharmacological and non-pharmacological techniques have been used to treat phlebitis. Aloe vera gel and warm compress are non-pharmacological nursing methods for phlebitis.

The present study compares the effect of Aloe vera and warm compress on pain due to phlebitis in children admitted to pediatric wards.

This single-blind clinical trial study was conducted on 90 children with phlebitis. The participants were selected using convenience sampling and randomly assigned to three control, Aloe vera compress intervention, and warm compress intervention groups. The data in this study were collected using the patient demographic information questionnaire andWong-Baker Faces Pain Rating Scale. The pain scores were evaluated in all three groups before the intervention. The intervention for the children in the warm compress group was a warm compress for 20 minutes twice daily (once every 12 hours). The intervention for the Aloe vera compress group was 5 cc of Aloe vera gel applied twice daily (once every 12 hours) for three days. Pain intensity was recorded and assessed in the pre-intervention stage for the children in all three groups. It was also measured for the warm compress group half an hour after the intervention and for the Aloe vera group at the beginning of the intervention. Pain intensity was also measured and evaluated for the children in the control group. Data analysis was performed with SPSS-22 software at a significance level of less than 0.05 (P < 0.05) using the chi-square test, independent samples t-test, one-way analysis of variance (ANOVA), and Fisher’s exact test.

The ANOVA results showed that there was no statistically significant difference between the three groups (P > 0.05) in the average pain intensity scores before the intervention and the first day after the intervention, but the average pain intensity scores in the three groups on the second day (P = 0.04) and the third day (P = 0.002) showed a statistically significant difference after the intervention. On the third day, the difference in the pain intensity scores was significant between the two intervention groups (P = 0.03) and the control group. Moreover, the pain intensity score for the children in the Aloe vera group decreased more significantly compared to the warm compress group (P = 0.001).

The results showed that applying both Aloe vera and warm compresses effectively reduced the pain induced by phlebitis, but Aloe vera reduced the pain caused by phlebitis more than warm compress. Thus, the Aloe vera compress can be used as an easy and simple method to reduce the pain caused by phlebitis.

The escape room game is a very useful and effective learning process used to teach various medical students, including nursing students. Escape rooms are increasingly used in higher education to supplement traditional teaching methods, allowing students to recall and apply knowledge gained in the classroom. In addition, given that the escape room is fun, it encourages them to study.

This systematic review aims to investigate the impact of using escape rooms in nursing education and their effectiveness in evaluating students' competencies.

This scoping review adhered to the PICO systematic review guidelines. The present study is a targeted and integrated review. First, a comprehensive search was conducted using keywords related to "escape room", "nursing education", "assessment", "evaluation" and "student learning" in Elsevier, SID, Magiran, Google Scholar, Science Direct, and PubMed databases to identify relevant studies published between 2010 and 2024. The studies about the effect of escape rooms on the teaching and learning of nursing students were included.

The first search identified 150 articles. After a more detailed review based on the purpose of the current research, 35 articles were included in the second phase of the study. Finally, after reviewing the full text, 10 articles reported the use. These articles' findings have shown that using escape rooms in nursing education improves student participation, teamwork, effective communication, and problem-solving skills. By carefully designing and implementing escape room activities, nursing educators can increase student engagement, teamwork, critical thinking, and problem-solving skills in a fun and interactive way.

This review provides valuable insights into the benefits and potential challenges of incorporating escape rooms into nursing curricula. The immediate feedback and other advantages make escape room training a valuable addition to nursing education. However, it's important to note that more research is needed to fully establish the validity and reliability of using escape rooms as an assessment tool in nursing education.

In light of the global spread of COVID-19 and its profound impact on public health and casualties, nurses have been thrust onto the front lines in the battle against this disease, resulting in heightened psychological distress and anxiety. Addressing these issues promptly and effectively is crucial during these challenging times. Therefore, this study aims to investigate the impact of telenursing training in reducing death anxiety among nurses with a history of COVID-19.

This quasi-experimental study involved two groups of 20 nurses with a history of COVID-19 and higher levels of death anxiety. Data were collected using Templer's death anxiety questionnaire and a demographic information questionnaire. In the test group, the intervention was conducted through WhatsApp groups over five sessions. Training methods to reduce death anxiety were presented through explanatory text, PowerPoint presentations, and audio files, with five-day intervals between sessions. The control group did not receive any intervention. Twenty days after the sessions, both groups completed the death anxiety questionnaire again. Data were analyzed using t-tests and chi-square tests.

The findings indicated a significant difference in the average score of death anxiety between the test and control group after telenursing training (p<0.05).

Telenursing training effectively reduces death anxiety among nurses with a history of COVID-19. Telenursing proves to be a cost-effective and organized intervention for managing symptoms, early diagnosis of complications, ensuring post-care quality, exchanging information, and providing health education.

Weight is one of the main indicators of physical growth and brain development in infants, especially preterm infants. Feeding preterm infants is an ongoing challenge for those in charge of feeding infants, especially those with very low birth weights. Feeding difficulties in premature infants lead to long hospital stays and increased costs.

This study aimed to compare the effects of cup feeding and finger feeding techniques on weight gain in premature infants.

This randomized clinical trial study was conducted on 90 premature infants with an average weight of 1784.3 ± 497 g admitted to the neonatal intensive care unit (NICU) of Ali Bin Abi Talib (AS) Hospital located in Zahedan, the southeast of Iran, in 2021. The infants were randomly divided into 3 groups: Cup feeding, finger feeding, and control groups (each with 30 infants). The intervention was performed for 3 consecutive days without interruption, even on holidays for each infant. The amount and frequency of feeding each infant depended on the birth weight and the diagnosis of a specialist. The infant’s weight was recorded before and after the intervention. Data analysis was performed using SPSS version 22 using analysis of variance (ANOVA), paired-samples t-test, and chi-square test.

The average weight of infants significantly increased in the cup feeding (P < 0.01) and finger feeding (P < 0.01) groups compared with the control group. The highest weight gain was recorded in the finger feeding group (109.55 g), followed by the cup feeding group (65.8 g) and the control group (31.1 g; P = 0.001). The ANOVA results suggested that the finger feeding technique was most effective in gaining weight and achieving independent oral feeding in premature infants.

The most common endocrine disease in childhood and adolescence is type I or insulin-dependent diabetes. Mothers are particularly anxious and worried because of the uncertainty in the role of motherhood and the future of the child. Therefore, the present study was conducted to investigate the effect of educational programs on the anxiety of mothers having children with type I diabetes.

The present semi-experimental research was conducted with a pretest-posttest design on 40 mothers with type 1 diabetic children. By being present in the research environment, encouraging the mothers to participate, and considering the criteria for entering the study, the researcher selected the subjects using the purposive sampling method and randomly placed them in two intervention and control groups. The number of sessions based on the needs and conditions of the patient's mother was considered to be at least three 30-minute sessions with an interval of every other day. The data collection tool was a two-part questionnaire consisting of a demographic information form and the 40-item Spiel Berger State-Trait Anxiety Inventory. The validity and reliability of the questionnaire have been confirmed in various studies. The obtained data were analyzed in the SPSS 21 software with the help of descriptive statistics. The significance level in this study was 0.05.

The data analysis showed that the two groups did not differ significantly in terms of child's age, gender, maternal age, maternal education, number of children, and duration of diabetes. The mean score of dimensions and the total anxiety score of the study samples in the intervention group were improved after the intervention; however, this difference was not significant.

Mothers of children with diabetes in the intervention group had lower scores in anxiety and its dimensions after the training. In other words, the intervention improved the anxiety scores of mothers. According to the results, it can be suggested that at the beginning of children's hospitalization in the ward, their educational needs and their mothers' needs be checked and the educational content be prepared and adjusted accordingly to reduce mothers' anxiety.

Burn patients who may be hospitalized for a few days to a few months find themselves in an unfamiliar environment over which they often have no control. Since the successful management of these patients requires a comprehensive understanding of their experiences, this study aimed to explain the burn patients’ experiences of hospitalization using a content analysis approach.
The present study was conducted using a qualitative design with a conventional content analysis approach. The participants were 9 burn patients admitted to the burn unit of Amir al-Momenin Ali Hospital in Zabol in 2019 who were selected through purposive sampling. The data were collected using semi-structured interviews. The collected data were analyzed based on the steps proposed by Graham and Landmann. The validity and robustness of the data were checked.
Based on the results of data analysis, 2 main categories and 5 subcategories were extracted: (1) bitter moments of hospitalization (emotional bitterness during hospitalization, bitter dressing moments, and bitter moments of pain perception) and (2) duality of nursing care (lack of nursing care and nurses’ compassionate care).
The analysis of the experiences of the burn patients showed that they experienced bitter moments after their hospitalization, while in addition to compassionate care, sometimes they felt the lack of nursing care. It is hoped that this study, by providing a clear picture of the hospitalization experiences of burn patients, can help officials and managers of burn units to take appropriate measures to address existing nursing care gaps, improve the hospitalization of these patients, and guide the implementation of nursing care strategies at the time of hospitalization of these patients.

Iron oxide nanoparticles are one of the most applied metal nanoparticles with advantageous properties in biomedicine that can be cost-effectively and rapidly produced through green synthesizing methods. The purpose of this study was to study the toxicity of iron oxide nanoparticles (Fe2O3 NPs), which were green synthesized by Prosopis farcta extract, on brain glioblastoma cells (U87). Powder X-ray Diffraction (PXRD), Vibrating-Sample Magnetometer (VSM), Field Energy Scanning Electron Microscopy (FESEM), Energy-Dispersive Spectroscopy (EDX), and Raman technics were performed to evaluate the physicochemical properties of this product. According to results, the green synthesized Fe2O3 nanoparticles contained a spherical morphology in the size range of 20-45 nm with superparamagnetic features. Additionally, their cytotoxic activity was surveyed against U87 cells by MTT assay, and the outcomes indicated the lack of any cytotoxic activity until reaching the concentration of 500 μg/mL. Therefore, our synthesized Fe2O3 NPs can be proposed as a proper candidate for being applied in the drug delivery of cancer treatments.

The painful procedure of drawing blood from the heel (heel lance) in the neonatal intensive care unit (NICU) is necessary for some diagnostic tests. However, it can have negative effects on the physiological criteria of preterm neonates. This study aimed to compare the effect of lullaby and kangaroo care on the physiological criteria of preterm neonates admitted to the NICU during heel lance.
This clinical trial study was conducted with a crossover design on 60 preterm newborns (30-36 weeks of gestation) admitted to the NICU at Ali ibn Abi Taleb Hospital, Zahedan, Iran, 2019. The neonates were randomly divided into two groups of lullaby and kangaroo care (n=30 each). In the former group, a lullaby was played for the neonates through headphones for 30 min, and in the latter group, the naked neonate was placed in the mother's arms for the same duration. Physiological criteria were recorded before (0 min), during (15 min), and after the procedure (30 min). The collected data were analyzed in SPSS software (version 22) using independent t-tests and Chi-square test.
There was no statistically significant difference between the mean scores of gestation age of neonates in the lullaby (32.63±1.92) and kangaroo care (32.69±1.92) group (P=1.000). The results of the independent sample t-test showed that during the intervention, there was a difference between the mean pulse rate (P=0.015), respiration rate (P=0.003), and arterial oxygen saturation percentage (P<0.01) in preterm neonates. The two groups were significantly different in this regard. However, in the post-intervention stage, no statistically significant difference was observed between the mean pulse rate and respiration rate (P=0.60 and P=0.614, respectively).
Given the positive effect of kangaroo care on the physiological criteria of preterm newborns during heel lance, this non-pharmacological, low-cost, and available method could help nurses working in the NICU improve physiological criteria during heel lance.

 Premature babies face nutritional problems caused by underdevelopment and lack of coordination between sucking, swallowing, and breathing. Appropriate early interventions are needed to promote the nutritional adequacy of these infants.

 This study was designed to compare the effect of breast milk odor and incubator cover on the nutritional adequacy of premature infants.

 A quasi-experimental study was conducted on 105 preterm infants aged 28 - 33 weeks who were admitted to the Neonatal Intensive Care Unit (NICU) of Ali Ibn Abi Taleb Hospital in Zahedan in 2018. The subjects were selected via convenience sampling and randomized into three groups: breast milk odor (BMO), incubator cover (IC), and control. Infants in the IC group were placed in an incubator for two hours before feeding. In the BMO group, a gauze soaked with breast milk was placed 1.5 cm away from the infant’s nose in the incubator, and a prescribed amount of milk was given by a syringe to the infant through the mouth. The amount of milk that the baby orally received in the first 10 min (nutritional adequacy) was recorded by a camera, and the results were compared in the three groups.

 One-way analysis of variance showed a statistically significant difference between the control group and the two groups of incubator cover and breast milk odor (P < 0.001) such that nutritional adequacy was lower in the control group than in the two other groups.

 Both the smell of breast milk and incubator cover improved the nutritional adequacy of premature infants and enabled them to orally receive more breast milk.

Nurses are one of the most important components of health care system who’s physical and psychological problems directly affect the quality of health servicescares provided to patients. Logic therapy can be a new way to bring meaning and meaning into work life. The purpose of this study was to determine the effect of group logo therapy on burnout in intensive care unit nurses.

This study is a quasi-experimental study with two groups which conducted on 40 nurses working in CCU - ICU-PICU-NICU wards of Amiralmomenin Ali hospital in Zabol city in 2018 which had higher level of burnout. The data collection tool was a two-part questionnaire, the first part related to demographic questionnaire and the second part Maslach burnout questionnaire. Before intervention, both groups completed the questionnaires and then for the experimental group 5 sessions of one hour of Logic Therapy 2 sessions per week were performed. Data were analyzed by SPSS software version 22 using t-test and chi-square tests.

The results showed that the mean scores of burnout severity in the experimental and control groups before the intervention were 69.55 and 77.10, respectively. After the intervention, the mean burnout severity decreased to 52.5 after intervention. There was no significant difference in the mean of the control group after the intervention. There was also a significant difference in the three domains of emotional exhaustion, depersonalization, and occupational involvement in the post-test (p <0.05). Demographic variables have no effect on job burnout (p> 0.05).

The results of this study showed that logo therapy can significantly reduce the severity and burnout of nurses in intensive care units. It seems that this type of psychotherapy can be used to reduce burnout in sensitive and anxious jobs.

Nurses form the largest group of burn care treatment team. They have valuable experiences regarding the care of burned patients that needs to be explored. Therefore, the present study was aimed to explain the experiences of nurses who work in the burn unit.

This qualitative study was conducted in the burn units of Zabol and Zahedan Hospitals in 2018. Accordingly, the data were collected through a semi‑structured deep interview with 16 nurses. Purposeful sampling method was used for data collection. The data were analyzed using a thematic analysis approach.

The data analysis ultimately led to the development of 4 themes and 16 sub‑themes. The extracted themes included burden of burn unit, toil of burn unit as a deal with God, need for continuing the education program, and work‑life imbalance.

Nurses in burn unit experience many challenges that can affect their job and life, which require special attention of the authorities, their families, and other colleagues. For better patient care, there is a need for up‑to‑date facilities and training. The hospital managers should pay more attention to the nursing staff of the burn units through increasing staff number, changing the working units, and offering

Adherence of type II diabetic patients to treatment is very important in preventing the complications of this disease. Furthermore, a motivational interview is an intervention considered to change health behaviors. Therefore, the current study aimed to determine the impact of the motivational interview based on self-care on the treatment adherence of type II diabetic patients hospitalized in Nabi Akram hospital in Zahedan, Iran, in 2018.

In this semi-experimental study, 40 diabetic patients were selected and randomly divided into intervention (n=20) and control (n=20) groups. Data collection tools for this study were demographic questionnaire and adherence questionnaire in patients with chronic diseases. The intervention group received four sessions of individual self-care motivational interview training. Moreover, the control group received similar training content during four sessions in the usual face-to-face manner without applying the principles of motivational interview. Adherence was measured in both groups 8 weeks after the termination of intervention. Then, the collected data were analyzed by the independent t-test and analysis of covariance using SPSS software (23).

After the intervention, the mean adherence score of diabetic patients in the intervention group (150/57) was significantly higher than the mean score of the control group (141/27) (P<.001).

Motivational interview training based on self-care has positive impact on the adherence of type II diabetic patients to treatment. Therefore, the nurses are suggested to apply the principles of motivational interview while training these patients.

Gestational diabetes is a common disease during pregnancy which has many effects on the health of the neonates.This study aimed to evaluate the complications affecting newborns of diabetic mothers.

The present study is an integrated review of available evidence and information based on published articles available in domestic and foreign electronic journals, selected from databases, such as SID, MAGIRAN, IRANMEDEX, PUBMED, GOOGLE SCHOLAR, and CINHAL. The search was carried out using keywords, including "Gestational diabetes mellitus", "Complications", "Neonates", and similar words. In total, 274 articles were found, out of which 232 studies were excluded, and finally, 42 Persian and Latin articles were examined in this study.

The most significant complications affecting newborns of mothers with gestational diabetes include macrosomia, respiratory distress, congenital anomalies, and disorder in their Apgar scores.

According to the results, it is recommended that all mothers with gestational diabetes be undergone periodic blood glucose monitoring and fetal examinations during pregnancy and be provided with special care at follow-ups and evaluation of the health of the child after birth.

Nanoparticles are particles that have at least one dimension between 1 and 100 nanometers. Nanoparticles are a new generation of antimicrobial agents. Nanoparticles with antimicrobial activity, especially as a new class of biomedical materials for use in increasing the level of public health in daily life have emerged. Zinc oxide nanoparticles have attracted a great attention due to the variety of their applications in medical science. The aim of this study was to evaluate and compare the antimicrobial activity of zinc oxide nanoparticles synthesized by green method.
This experimental study was done in 2017, from March to September in the Bam Research Center of University of Medical Sciences Kerman, Iran. Green synthesis of zinc oxide nanoparticles was investigated using cumin seeds. The physicochemical characteristics of synthesized nanoparticles were studied by UV-visible ultraviolet spectrometer (Analytik Jena AG, Germany), X-ray diffraction and transmission electron microscope (TEM) (Carl Zeiss, Germany). Broth microdilution method was used to investigate the antimicrobial activity of zinc oxide nanoparticles. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of these nanoparticles were determined for Pseudomonas aerogenes and Enterococcus faecalis strains.
The UV-visible ultraviolet spectroscopy showed an absorption peak in the range of 370 nm. Transmission electron microscopy shows the synthesis of zinc oxide nanoparticles, mostly spherical, with a size less than 50 nm. Minimum inhibitory concentration of zinc oxide nanoparticles against P. aerogenes and E. faecalis strains was determined at 6.25 and 12.5 μg/ml, respectively. Both bacteria were sensitive to zinc oxide nanoparticles. This sensitivity was higher for gram-negative bacteria.
Zinc oxide nanoparticles were produced using Iranian natural resources and our results showed significant antibacterial activity. Nanotechnology creates materials with novel properties every day, and creates new hope for improving environmental pollution. These nanoparticles can be used as a new generation of antimicrobial agents in various medical disciplines. For example, toothpaste containing zinc nanoparticles can be produced and prescribed for patients with immune deficiency to prevent the growth of microbial pathogens in the mouth and its transmission to the patient's body.

Adolescents have unique developmental requirements and medical needs which make them different from adults and children. In addition, they have problems of different natures, but they receive health services from common service. The aim of this study was to describe the hospitalization experience in adolescents.
Using qualitative method, in-depth semi-structured interviews were conducted with a purposeful sample of 9 adolescents between the ages of 10 and 19 years, who were hospitalized in Zabol hospital pediatric ward, Zabol City, Iran. The data were analyzed based on Colaizzi's method. Rigors of the study were achieved by paying attention to four criteria: real value, applicability, consistency, and factuality.
Adolescent's experience of hospitalization was constructed by four main concepts concluding separation from family and friends, staying on an unfamiliar environment, fears of treatment, and limitation of individual autonomy.
Adolescents mostly are afraid of anonymous routines, procedures, and hospital personnel. Before the hospitalization of adolescents, there should be preparation plans for them; they often look for discipline and security in an unfamiliar environment. Therefore, hospital should be a safe place; so that, the adolescents` anxiety and worries can be reduced on the way from home to the hospital. It is suggested that professional staff view the design and routines of the ward from the perspective of adolescents; also it is better to perform adolescent-centered activities.

Snowball sampling is applied when samples with the target characteristics are not easily accessible. This research describes snowball sampling as a purposeful method of data collection in qualitative research. This paper is a descriptive review of previous research papers. Data were gathered using English keywords, including “review,” “declaration,” “snowball,” and “chain referral,” as well as Persian keywords that are equivalents of the following: “purposeful sampling,” “snowball,” “qualitative research,” and “descriptive review.” The databases included Google Scholar, Scopus, Irandoc, ProQuest, Science Direct, SID, MagIran, Medline, and Cochrane. The search was limited to Persian and English articles written between 2005 and 2013. The preliminary search yielded 433 articles from PubMed, 88 articles from Scopus, 1 article from SID, and 18 articles from MagIran. Among 125 articles, methodological and non-research articles were omitted. Finally, 11 relevant articles, which met the criteria, were selected for review. Different methods of snowball sampling can be applied to facilitate scientific research, provide community-based data, and hold health educational programs. Snowball sampling can be effectively used to analyze vulnerable groups or individuals under special care. In fact, it allows researchers to access susceptible populations. Thus, it is suggested to consider snowball sampling strategies while working with the attendees of educational programs or samples of research studies.

Extention of knowledge and informations is given new meaning to the concept of education. One of The most important reasons for the use of e-learning in medical education are that learning done by the learner own. This method facilitates their Individualized education programs. This study introduced about the challenges and solutions for the achievement of e-learning in medical education.
This is a review article that was implemented a comprehensive review using the World Wide Web. The databases were used such as Medline, Ovid, ProQuest, and PubMed and by the key words “e-learning, educational challenges and medical education” in Persian and English languages. Of the 80 founded articles, 30 articles were chosen related to the objective.
Researchs show that e-learning despite of advantages and wide applications have chalenges, including the lack of implementation by lecturer due to lack of knowledge of its functioning, the fading role of lecturer, lack of expertise in its application, fear of its application, special cultural beliefs and insufficient resources can be cited.
It is nessessory to be considerd to establish standards and substractures for achieving the implementation of e-learning in medical medical education. Beacause to inexperience of universities of medical sciences in Iran comparison with other universities in around the world, so suggested to use from experiences of the master countries. Also helding the workshops base e-learning can be effective.

Adolescent pregnancy is a complex issue, and it is considered as a social- health problem. Present study aimed to examine the experiences of teenage mothers of their pregnancy and motherhood in Tabriz city. In this qualitative phenomenological study, purposive sampling was used to select participants among women referred to Tabriz health centers, and it continued up to data saturation. The data were collected through semi-structured interviews with 11 adolescent mothers in the age of 15-19 years and were analyzed using conventional content analysis. 6 categories including need to family support, need to education, physical complications, religious beliefs, feeling of capability and maturation and negative feelings due to early pregnancy and parenting were merged. Comprehensive support and achieving to self-esteem were the main themes that were identified in this study. Becoming a mother during the adolescence is a difficult struggle because of inexperience, unprepared for motherhood and relying on others for support. Based on the findings of this study, adolescent mothers need to get a comprehensive support. In addition doing motherhood responsibility properly can help achieving mothers’ self-esteem. Support of spouse, family members, and also health care providers to this vulnerable group can have a positive impact on physical and emotional condition of adolescent mothers and their infants.